HENRY OKAFOR
Subscriber on policy B03M000424
Claims
2
Attributed to this person
Charged
1,026.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
36.60
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | HENRY OKAFOR |
| Role on the policy | Subscriber |
| Policy | B03M000424 |
| Date of birth | 2 Jul 1999 |
| Plan | BRONZE EPO |
| Covered from | 30 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 36.60 |
| Total | 36.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001726 | 15 Aug 2025 | 183.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001725 | 16 Sep 2024 | 843.00 | NORTHSTAR MUTUAL | Not denied | — |